Geographic Variation and Factors Associated with Female Genital Mutilation among Reproductive Age Women in Ethiopia: A National Population Based Survey

Female genital mutilation/cutting among girls aged 0-14: evidence from the 2018 Mali Demographic and Health Survey data

BACKGROUND

Female genital mutilation/cutting (FGM/C) is considered a social norm in many African societies, with varying prevalence among countries. Mali is one of the eight countries with very high prevalence of FGM/C in Africa. This study assessed the individual and contextual factors associated with female FGM/C among girls aged 0-14 years in Mali.

METHODS

We obtained data from the 2018 Mali Demographic and Health Survey. The prevalence of FGM/C in girls was presented using percentages while a multilevel binary logistic regression analysis was conducted to assess the predictors of FGM/C and the results were presented using adjusted odds ratios with associated 95% confidence intervals (CIs).

RESULTS

The results indicate that more than half (72.7%, 95% CI = 70.4-74.8) of women in Mali with daughters had at least one daughter who has gone through circumcision. The likelihood of circumcision of girls increased with age, with women aged 45-49 having the highest odds compared to those aged 15-19 (aOR = 17.68, CI = 7.91-31.79). A higher likelihood of FGM/C in daughters was observed among women who never read newspaper/magazine (aOR = 2.22, 95% CI = 1.27-3.89), compared to those who read newspaper/magazine at least once a week. Compared to women who are not circumcised, those who had been circumcised were more likely to have their daughters circumcised (aOR = 53.98, 95% CI = 24.91-117.00).

CONCLUSION

The study revealed the age of mothers, frequency of reading newspaper/magazine, and circumcision status of mothers, as factors associated with circumcision of girls aged 0-14 in Mali. It is, therefore, imperative for existing interventions and new ones to focus on these factors in order to reduce FGM/C in Mali. This will help Mali to contribute to the global efforts of eliminating all harmful practices, such as child, early and forced marriage and female genital mutilation by 2030.

Do Attitude, Awareness and Intention to Perform Female Genital Mutilation or Cutting for Their Daughters of Women Healthcare Providers Differ from Mothers in Somalia?

Aim

This study aimed to determine whether there were differences in attitude, awareness, and intention to perform female genital mutilation or cutting for their daughters in the future between female healthcare providers and mothers.

Methods

A comparative cross-sectional study design was used.

Results

A total of 508 women were included in the study. Of the participants, 68.7% (n = 349) were mothers (Group I) who visited the hospital and 31.3% (n = 159) were women healthcare professionals (Group II) [27% (n = 137) nurses and 4.3% (n = 22) doctors]. It was found that 8 (1.6%) of the participants did not have FGM/C and the FGM/C ratio was lower in group II (95%) than in group I (100%) (p < 0.001). In group I, 99.7% (n = 299) of the participants and 30.6% (n = 19) of those in group II reported intending to perform FGM for their daughters in the future (p < 0.001). The reasons for FGM/C most cited by participants were a traditional rite of passage into womanhood (78%), religious requirement (69.3%), and preservation of their virginity until marriage (59.3%). "Stop FGM" was given as a message on FGM/C by 60% of the participants (n = 79) who answered (n = 127, 100%) to open-ended questions.

Conclusion

The results of this study show that female health professionals with higher education and monthly income had less positive perception of their FGM/C and less intention to allow their daughters to undergo FGM/C.

Use of machine learning methods to understand discussions of female genital mutilation/cutting on social media

Female genital mutilation/cutting (FGM/C) describes several procedures that involve injury to the vulva or vagina for nontherapeutic reasons. Though at least 200 million women and girls living in 30 countries have undergone FGM/C, there is a paucity of studies focused on public perception of FGM/C. We used machine learning methods to characterize discussion of FGM/C on Twitter in English from 2015 to 2020. Twitter has emerged in recent years as a source for seeking and sharing health information and misinformation. We extracted text metadata from user profiles to characterize the individuals and locations involved in conversations about FGM/C. We extracted major discussion themes from posts using correlated topic modeling. Finally, we extracted features from posts and applied random forest models to predict user engagement. The volume of tweets addressing FGM/C remained fairly stable across years. Conversation was mostly concentrated among the United States and United Kingdom through 2017, but shifted to Nigeria and Kenya in 2020. Some of the discussion topics associated with FGM/C across years included Islam, International Day of Zero Tolerance, current news stories, education, activism, male circumcision, human rights, and feminism. Tweet length and follower count were consistently strong predictors of engagement. Our findings suggest that (1) discussion about FGM/C has not evolved significantly over time, (2) the majority of the conversation about FGM/C on English-speaking Twitter is advocating for an end to the practice, (3) supporters of Donald Trump make up a substantial voice in the conversation about FGM/C, and (4) understanding the nuances in how people across cultures refer to and discuss FGM/C could be important for the design of public health communication and intervention.

Spatial distribution and multilevel analysis of the ideal number of children among Ethiopian women

BACKGROUND

Ideal number of children (INC) is the number of children that a woman or man would have if they could go back to the time when they did not have any children and could choose accurately the number of children to have in their total life. Despite numerous studies on the prevalence and associated factors of the ideal number of children, there is a lack of studies that incorporated spatial and multilevel analysis. Thus, this study was aimed at the spatial and multilevel analysis of an ideal number of children and associated factors.

METHODS

The study design was a cross-sectional study in which the data was obtained from Ethiopian Demographic and Health Survey (EDHS) in 2016. About 13,961 women ages 15-49 who fulfill the inclusion criterion were considered. A negative binomial regression model that incorporates spatial and multilevel analysis was employed.

RESULTS

About 33 and 12.8% of the women had four and six ideal numbers of children respectively. The highest INC per woman was recorded in Oromia region 5055 (36.1%) and the lowest in Harare 35(0.2%). The INC per woman is high in rural 10,726 (76.6%) areas as compared to urban areas 3277(23.4%). The ideal number of children was spatially clustered (Global Moran's I = 0.1439, p < .00043). Significant hotspot clusters were found in the Somali region such as in Afder, Shabelle, Korahe, and Doolo zone.

CONCLUSION

The spatial analysis revealed a significant clustering of the ideal number of children in the Ethiopia zone. Specifically, higher INC was observed in the Somali region, specifically in the Afder, Shabelle, Korahe, and Doolo zones. Among the various factors considered, women's age, region, place of residence, women's education level, contraception use, religion, marital status, family size, and age at first birth year were identified as significant predictors of the ideal number of children. These findings indicate that these factors play a crucial role in shaping reproductive preferences and decisions among women in the study population. Based on these findings, responsible bodies should prioritize targeted interventions and policies in high-risk regions to address women's specific reproductive needs.

Effect of parental attitudes on the practice and medicalization of female genital mutilation: a secondary analysis of Egypt Health Issues Survey, 2015

Background

Despite the observed decrease in female genital mutilation (FGM) prevalence, it is increasingly being medicalized. We examined the attitudes of both parents towards the FGM practice in Egypt, and highlighted the effect of fathers’ decision making and attitudes towards FGM and violence on FGM practice and medicalization.

Methods

This study is a secondary analysis of Egypt Health Issues Survey (EHIS), 2015. The 2015 EHIS involved a systematic random selection of a subsample of 614 Shiakhas/villages out of the 884 shiakhas/villages that had been chosen as Primary Sampling Units in the 2014 EDHS. Descriptive statistics of the study sample and parents’ attitudes was performed. Three indices were created describing; mothers’ and fathers’ attitudes towards FGM, decision making and rejecting violence against women. Bivariate and multivariable analyses were conducted to identify predictors of FGM practice and medicalization.

Results

A considerable proportion of EHIS girls; 16.4% were circumcised and 36% of girls were expected to be circumcised. More than two thirds of circumcised girls were circumcised by a physician; namely 67% and 13.5% by nurses. The majority of mothers (88.4%) and fathers (84.8%) believed that FGM practice should continue. They believed that FGM is a religious obligation (72.3% of mothers and 73% of fathers). Parents believed that husbands prefer a circumcised wife (81.1% and 82.5% of mothers and fathers respectively). Being in the poorest wealth quintile (OR = 4.2, p < 0.001) and living in rural Upper Egypt (OR = 4.55, p < 0.001) were the predictors of FGM practice, while medicalization was more likely among the rich and educated parents. Parents’ attitudes supporting FGM was significantly associated with its practice (OR = 1.97, p < 0.001, for mothers and OR = 1.27, p < 0.001, for fathers). Rejecting violence against women was associated with less likelihood of practicing FGM (OR = 0.89, p < 0.05) and more likelihood of its medicalization (OR = 1.25, p < 0.01).

Conclusion

More attention should be paid to enforce the laws against FGM practice by health care providers. Raising the community awareness on girls’ human rights and elimination of FGM practice which is a severe form of violence against women and gender inequality in sexual rights should be prioritized with targeting men in FGM programs.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12905-022-01834-7.

Contribution of between region and neighborhood variation of socioeconomic factors on the practice of female genital mutilation/cutting: a multilevel analysis of Tanzanian national surveys

This study aimed to assess to what extent differences in socioeconomic factors between regions correlate to dramatic disparities in the prevalence of female genital mutilation/cutting (FGM/C) across Tanzania. The data from the 2004, 2010, and 2016 Tanzania Demographic Health Surveys were used in this analysis. The estimates from multilevel variance components for FGM/C were compared before and after adjusting for socioeconomic variables (residence, marital status, education, and wealth quintile) and age. The three-level structure of the sample sorted women into individual (level-1), neighborhood (level-2), and regional (level-3) categories. The pooled data included a total of 27587 women of reproductive age with a median age (IQR) of 29 (21–36) years. The random-effects results revealed that of the total age-adjusted variance in FGM/C, 76.7% was attributed to the between region and neighborhood differences. Despite the large between region variations, only 3.7% was explained by socioeconomic factors. Despite the large contribution of between region and neighborhood differences to variance in FGM/C prevalence, less of this variation was explained by socioeconomic factors. Therefore, it is possible that maternal and reproductive educational programs tailored to such neighborhood differences, beyond socioeconomic factors alone, could contribute to a radical shift in perspective for regions with high prevalence.

Does previous circumcision and wealth index influence women’s attitude to discontinue the practice of female genital mutilation and cutting (FGM/C) in Ethiopia?

Introduction

understanding women’s attitudes towards female genital mutilation is an important step towards eliminating this practice. We used the 2016 Ethiopia Demographic and Health Survey (EDHS) data set to examine the relationship between wealth index, and previous history of circumcision on women’s opinions whether female genital mutilation (FGM) should be continued or stopped in Ethiopia.

Methods

Data from 6984 women aged 15–49 years were extracted from the 2016 Ethiopia EDHS data set. Multivariable logistic regression analysis was performed to analyse the data.

Result

In this study, women with a higher level of education and wealth index were more likely to support the cessation of FGM. However, circumcised women (AOR: 0.22; 95% CI: 0.15–0.32), women from the Afar region (AOR: 0.34; 95% CI: 0.22–0.50), Somali region (AOR: 0.42; 95% CI: 0.27–0.65), and Dire Dawa region (AOR: 0.51; 95% CI: 0.32–0.83) were less likely to support discontinuation of FGM.

Conclusion

The present study revealed that wealth index, education level, history of circumcision, and regional variation are associated with women’s attitude towards discontinuation of the practice of FGM in Ethiopia. Empowering women in terms of socioeconomic status and education can change attitudes and might help prevent female genital mutilation in the future. Furthermore, interventions targeting FGM practices should focus on regional variance in order to have a meaningful impact on reducing this harmful cultural practice in Ethiopia.

Behavioral Barriers to Stop Female Genital Mutilation/Cutting in South Ethiopia: An Exploratory Qualitative Study of the Perspective of Women

Background

Female genital mutilation or cutting (FGM/C) is an act that violates the rights of girls and women and causes serious medical complications. Approximately 200 million women have undergone circumcision in 31 countries. Ethiopia, in particular, has the largest number of women who undergone FGM/C. Unfortunately, there has been minimal research into the reasons for this high prevalence in the country. Hence, this study has been conducted to explore behavioral barriers to stopping FGM/C in Southern Ethiopia.

Methods

An exploratory qualitative study was employed from October to November 2021 in two purposively selected zones of Southern Ethiopia. A purposive sampling technique was used to select respondents from the two zones. A total of fourteen study participants were selected and interviewed in-depth to obtain responses from various perspectives. A thematic content analysis was conducted to analyze the data collected from the field.

Findings

The study revealed that FGM/C is widely practiced in the study area. Respondents were found to have poor awareness and positive attitude towards continuation of FGM/C. This is possibly due to the social and cultural acceptability of the practice and influences from peers, families, future marriage partners and the community. The study shows that women are more likely to be circumcised because they want to be respected by their community, to be considered eligible for marriage and to avoid stigma and discrimination.

Conclusion

The continued practice of FGM/C was in considerable state to require the development of intervention strategies in order to eliminate it by 2030. The study’s findings recommend stronger legal actions against those who perform FGM/C, alongside behavior change communication interventions, to improve awareness of its risks and encourage the community to stop FGM/C.

Spatial Distribution and Associated Factors of Institutional Delivery among Reproductive-Age Women in Ethiopia: The Case of Ethiopia Demographic and Health Survey

Background

Maternal mortality is unacceptably high. About 295,000 women died during and following pregnancy and childbirth in 2017. The vast majority of these deaths (94%) occurred in low-resource settings, and most could have been prevented.

Methods

This research is based on a cross-sectional study using 2016 EDHS data. The analysis included 7,590 women who had given birth in the five years prior to the survey. Clusters with high and low hot spots with institutional delivery were found using SatScan spatial statistical analysis. A multilevel multivariable mixed-effect logistic regression was utilized to discover characteristics associated with institutional delivery.

Result

In this study, 33.25% of women who gave birth in the last 5 years preceding the survey delivered their babies at health institutions. The finding also indicated that the spatial distribution of institutional delivery was nonrandom in the country. Variables achieving statically significant association with utilization of institutional delivery were as follows: at the individual level, richness (AOR = 2.18, 95%CI: 1.39–3.41), higher education (AOR = 3.89, 95%CI: 1.51–10.01), a number of antenatal care visits of four and above (AOR = 6.57, 95%CI: 4.83–8.94), and parity of more than two children (AOR = 0.48, 95%CI: 0.34–0.68); at the community level, higher education (AOR = 1.70, 95%CI: 1.22–2.36) and urban residence (AOR = 5.30, 95%CI: 3.10–9.06) were variables that had achieved statically significant association for utilization of institutional delivery.

Conclusions

This study identified a spatial cluster of institutional delivery with the Somali and Afar region having low utilization rates and Addis Ababa and Tigray regions having the highest utilization rates. The significant individual factors associated with institution delivery were woman antenatal care visits, household wealth index, maternal education, and parity, and the significant community ones were region, place of residence, and educational status. Therefore, to maximize health facility delivery in Ethiopia, the predictors of institutional delivery identified in this study should be given more attention by governmental and nongovernmental stakeholders.

Neonatal care practice and associated factors among mothers of infants 0-6 months old in North Shewa zone, Oromia region, Ethiopia

Worldwide, the magnitudes of neonatal mortality are estimated to be about 3 million due to insufficient care. The burden of neonatal mortality is high in Ethiopia as compared to high and middle-income countries. The study aimed to assess the neonatal care practice and associated factors among mothers of infants 0-6 months old in Northern Shewa, Ethiopia. A community-based cross-sectional study design was undertaken on a mother living in the North Shewa zone from September 2019 to June 2020. Neonatal care practice was assessed by World Health Organization (WHO) minimum neonatal care package indicators. Over the study period, a total of 245 (62.0%) mothers had a good neonatal care practice. Being urban areas [AOR 5.508, 95% CI 2.170, 13.984], having ANC follow-up [AOR 3.042, 95% CI 1.031, 12.642], lack of adequate information [AOR 0.123, 95% CI 0.054, 0.282] and post-natal care (PNC) [AOR 5.779, 95% CI 2.315, 14.425] were predictors of good neonatal care practice. In our study, there was moderate neonatal care practice among mothers. Therefore, all elements of neonatal care packages should be studied at large.

Factors associated with men's opinion about female genital mutilation in Ethiopia

BACKGROUND

Female genital mutilation (FGM) is considered a human rights violation against women and girls causing serious short and long-term health complications. Despite being a criminal offence in Ethiopia since 2004, the practice continues. Minimal research has been published on factors associated with men's opinion about FGM in Ethiopia.

OBJECTIVE AND AIMS

The present cross-sectional study used secondary data to identify factors associated with men's opinions about the practice of FGM.

METHODS

Secondary data analysis was conducted using data from 8,718 men who responded to the 2016 Ethiopian Demographic and Health Surveys (EDHS). The dependent variable was men's opinion about FGM. Demographic, socioeconomic, and other characteristics were examined.

RESULTS

Variables associated with men's support for FGM were lack of education (AOR = 2.91; 95% CI: 1.93, 4.40, p = <0.001), poor wealth index (AOR, 1.76; 95% CI 1.32, 2.35, p = 0.001), ethnically Afar (AOR = 2.50, 95% CI: 1.27, 4.95, p = 0.009) and Somali (AOR = 2.02, 95% CI: 1.15, 3.54, p = 0.015), Muslim religion (AOR = 1.58, 95% CI 1.13, 2.50, p = 0.007), and support for wife beating with at least one justification (AOR = 2.04, 95% CI: 1.66, 2.50, p = <0.001).

CONCLUSION

Lack of education, poor household wealth index, being Muslim and being a member of the Afar or Somali ethnicity and having a tendency that it is appropriate for a husband to beat his wife, were positively associated support for FGM. These findings suggest that context-specific interventions are needed to eradicate the practice.

Female genital mutilation: prevalence, associated factors and health consequences among reproductive age group women in Keffa Zone, Southwest, Ethiopia

Background

Female genital mutilation is procedure involving partial or total removal of the external female genitalia for cultural or non-therapeutic reasons. Despite of global concerns, awareness, and campaigns, the prevalence of female genital mutilation remains high in many countries.

Objective

To assess female genital mutilation: prevalence, associated factors, and health consequences among reproductive age group women in Keffa Zone, Southwest, Ethiopia.

Methods

A community based cross-sectional study design was employed from March 01 to April 30, 2019. We used a multi stage sampling. Finally, using simple random sampling technique, we selected four Woredas. Consequently, after clustering kebeles, all mothers with daughter/s younger than 15 years and live in clustered kebeles were interviewed. Data were entered into Epi data and exported to SPSS version 23.0. Variables with P-value of less than 0.25 in binary logistic regression analyses were entered into the multivariable logistic regression analysis. Odds ratio with 95% confidence interval was used to determine associations between dependent and independent variables. P value less than 0.05 was considered statistically significant.

Results

Almost all, 729 (97.2%) of mothers expressed that they heard about female circumcision. However, less than one-fourth, 159 (21.2%) of mothers were circumcised. Among those 159 women ever circumcised, 52 (32.7%) reported that they experienced the complication of female genital mutilation.The prevalence of female genital mutilation of daughters’ younger than 15 years was 12 (1.6%). Rural residence [AOR 6.74, 95% CI (2.70–16.85)], being Muslim and Protestant follower by their religion [AOR 0.19, 95% CI (0.07–0.53] and [AOR 0.54, 95% CI (0.30–0.98)] respectively and occupational status of the husband; Merchant [AOR 7.29; 95% CI (3.66–14.51)], Daily laborer[AOR 2.70, 95% CI (1.14–6.40)] and others (drivers and students) [AOR 6.70, 95% CI (1.55–28.95] were statistically significantly associated with female genital mutilation.

Conclusion

In this study, prevalence of female genital mutilation practice among daughters and women of reproductive group was low as compared to a national data. However, that much magnitude still seeks attention as Ethiopia planned to end the practice. Religion, place of residence, and occupational status of the husband were statistically significantly associated with female genital mutilation. Therefore, any strategy to end up the practice better considers dimension of all these variables.

Female Genital Mutilation is a procedure involving partial or total removal of the external female genitalia for cultural or non-therapeutic reasons. The female genital mutilation is a practice associated with a variety of socio-cultural meanings and often considered as necessary for social acceptability. Despite global concerns, awareness and campaigns, the prevalence of female genital mutilation remains high in many countries. In spite of the prohibition practice, ending female genital mutilation is still a problem as the practice is conducted secretly and quietly.

It is important to know the prevalence and associated factors of female genital mutilation in the region to work on the problem. In this study, we have interviewed reproductive age group women in the community to explore the practice and associated factors of female genital mutilation among themselves and their daughters.

This study indicates that there is low prevalence of female genital mutilation in the region as compared to other region and national prevalence. Even though the practice is low in the region, it needs an attention to ending up the practice. This study findings suggests that deep study is needed to explore the connection between religion and female genital mutilations

Variations in the Prevalence of Female Genital Mutilation Among Reproductive-aged Women in Nigeria Across Three Generations

BACKGROUND AND OBJECTIVE

Female genital mutilation (FGM) is widespread mainly in low and middle-income countries. Nigeria is one of the countries with the highest prevalence of FGM, accounting for about one of every four cases globally. The purpose of this study was to determine the prevalence of FGM among three generations in Abuja, the federal capital city of Nigeria.

METHODS

This is a cross-sectional study among women of reproductive age (15-49 years) within two area councils of Abuja (Bwari and Abuja Municipal) and Nyanya suburban district adjoining the federal capital territory in Nigeria. The respondents are pregnant women attending antenatal care at four selected health facilities. Data were collected using Google Forms and were analyzed with SPSS for Windows version 25.

RESULTS

This study comprised data from 634 females (who had an average age of 33±6.0 years) from four major healthcare facilities in Abuja. The most common age group was 30 - 34 years (29.2%). The prevalence of FGM in the first generation (37.7%) was significantly higher than in the second (28.5%) and the third generations (8.7%) (p<0.01). The prevalence of FGM in the second generation was also significantly higher than in the third (p<0.01). The predictors of women circumcising their daughters include primary/no-education AOR 1.48 (95% CI: 0.41-5.31; p<0.05), being a traditionalist 4.94 (95% CI: 0.29-84.56; p<0.05), or Muslim 2.27 (95% CI: 0.94-5.49; p<0.05), respondent's mother being circumcised 1.69 (95% CI: 0.26-10.85, p<0.05) or mother's circumcision unknown 5.41 (95% CI: 0.78-37.34; p<0.05), respondents being circumcised 54.71 (95% CI: 0.78-37.34; p<0.001), culture 2.48 (95% CI: 1.00-6.19; p<0.05), and ignorance of adverse psycho-social/emotional effects of FGM 4.39 (95% CI: 1.46-13.17; p<0.05).

CONCLUSION AND GLOBAL HEALTH IMPLICATIONS

Although there is a decline in FGM prevalence from the first generation to the third generation in Nigeria, the current prevalence of 8.7% remains a public health concern. Nigerian women's ongoing experience of FGM requires both individual and stakeholders' involvement to eradicate health-related problems such as tissue damage, infection, scarring, infertility, and pains during sexual intercourse, urination, and menstruation.

Female genital mutilation/cutting in sudan and subsequent pelvic floor dysfunction

Background

We aimed to evaluate the socio-demographic characteristics of women with female genital mutilation/cutting (FGM/C) and the results of FGM/C due to pelvic floor dysfunction.

Results

The prevalence of FGM/C was 87.2% in Sudan and Type 3 (50.4%) was the most prevalent, followed by Type 2 (35%) and Type 1 (8.5%). In the multinominal logistic regression analysis performed to show the effect of FGM/C on pelvic organ prolapse (POP), it was observed that FGM/C frequency in POP group 2 was statistically similar when POP group 1 was taken as reference category. In the evaluation for symptomatic POP (POP group 3), risk of developing POP in patients without FGM/C was significantly lower than patients with type 3 FGM/C with a rate of 82.9% (OR(odds ratio): 0.171 (p: 0.002), (Confidence Interval (CI) %95; 0.058–0.511). Risk of developing POP rate in patients with type 1 FGM/C was 75% (OR:0.250 (p: 0.005), CI %95; 0.094–0.666) and in patients with type 2 FGM/C was 78.4% (OR:0.216 (p: 0.0001), CI%95; 0.115–0.406). In the multinominal logistic regression analysis including other variables affecting POP, when group 1 was taken as the reference category, it was found that the possibility of developing mild POP (group 2) decreased in FGM/C type 1 and 2 compared to FGM/C type 3 but it was not statistically significant. However, the evaluation for the symptomatic POP group showed up a significantly lower risk of developing POP in patients with type 2 FGM/C compared to patients with type 3 FGM/C, with a rate of 58.4%. (OR:0.419 (p: 0.016), CI%95; 0.206–0.851) (Table 3). In addition, older age was found to be significant risk factor for increasing symptomatic POP (p: 0.003).

Conclusions

Type 2 and 3 FGM/C continues to be an important health problem in terms of complications that may develop in advanced ages as well as many short-term complications as a result of mechanical or physiological deterioration of the female genital anatomy.

Effects of antenatal care visits and health facility delivery on women's choice to circumcise their daughters in sub-Saharan Africa: evidence from demographic and health surveys

Background

This study examines the association between maternal healthcare service utilisation and circumcision of daughters in sub-Saharan Africa (SSA).

Methods

This study is based on a cross-sectional study design that draws on analysis of pooled data from current demographic and health surveys conducted between 2010 and 2019 in 12 countries in SSA. Both bivariate and multivariable binary logistic regression models were employed.

Results

Mothers who had four or more antenatal care visits were less likely to circumcise their daughters compared with those who had zero to three visits. Mothers who delivered at a health facility were less likely to circumcise their daughters than those who delivered at home. With the covariates, circumcision of daughters increased with increasing maternal age but decreased with increasing wealth quintile and level of education. Girls born to married women and women who had been circumcised were more likely to be circumcised.

Conclusions

This study established an association between maternal healthcare service utilisation and circumcision of girls from birth to age 14 y in SSA. The findings highlight the need to strengthen policies that promote maternal healthcare service utilisation (antenatal care and health facility delivery) by integrating female genital mutilation (FGM) information and education in countries studied.

Attitude towards female circumcision among women in Ethiopia

Female genital mutilation or cutting (FGM/C) is a global phenomenon mostly practiced in Africa, Asia, and the middle east. It involves the removal of the external female genitalia for non-medical reasons. The practice cuts across different ethnic and religious groups in Africa and is associated with several health complications. The following study assessed attitude towards the practice among Ethiopian women aged 15-49. Using the Ethiopia Demographic and Health Survey from 2016 as a data source, we analyzed a sample of 6984 women. We used the respectable femininity discourse to inform our variable selection. The main outcome variable assessed whether women supported or rejected the continuation of the practice. In the bivariate analysis, all the sociodemographic variables including women's circumcision experience were strongly associated with the outcome variable. In the multiple logistic regression, only education, wealth, religion, and circumcision status were independently associated with women's attitude towards FGM/C. For instance, compared to women with no education, women with at least a secondary education were more than 4 times (AOR 4.2, 95% CI 2.53-7.04, P-Value < 0.001) more likely to agree with the termination of the practice. Our findings suggest that changing attitudes towards FGM/C may require uplifting the social and economic status of women, working with those who have experienced FGM/C and collaborating with religious leaders.

Female Genital Mutilation in Ghana: Prevalence and Socioeconomic Predictors

Background

Each year, not less than three million women are circumcised, and more hundred million females have already been circumcised. In many African societies, the practice of female genital mutilation (FGM) is a serious cultural practice. Aim: This current study is aimed at identifying the socioeconomic predictors of female genital mutilation in Ghana.

Methods

The design adopted for this study was a descriptive cross-sectional survey relying on data from the Ghana Multiple Indicator Cluster Survey (MICS) 2017/18. SPSS software was used for data analysis. Chi-square and binary logistic regression were used for associations.

Results

Overall FGM prevalence, this study recorded was 11.7%. The region with the highest (50.5%) prevalence was the Upper West Region. Area of residence predicted rural (AOR = 2.30, 95%C.I. = 1.75-3.00) Upper West/western Region (AOR = 1.84, 95%C.I. = 1.23-2.75). In terms of ethnicity, the tribes that predicted FGM when compared with the Akan tribe were Guan (AOR = 8.91, 95%C.I. = 3.53-22.51), Gruma (AOR = 6.45, 95%C.I. = 2.91-14.31), Mole-Dagbani (AOR = 38.10, 95%C.I. = 21.20-68.49), Grusi (AOR = 45.30, 95%C.I. = 24.47 - 83.49), Mande (AOR = 68.58, 95%C.I. = 30.85 - 152.42), and other tribes (AOR = 29.33, 95%C.I. = 16.11-53.39). Women in the richest/poorest wealth index quintile (AOR = 1.80, 95%C.I. = 1.19-2.72).

Conclusion

The study prevalence of FGM is still high in the northern part of Ghana, and the predicted factors were residence region, ethnicity, educational level, and economic status.

Empirical linkages between female genital mutilation and multiple sexual partnership: evidence from the 2018 Mali and 2013 Sierra Leone Demographic and Health Surveys

Female genital mutilation (FGM) is very pervasive in Africa, with significant regional variations in the prevalence of this traditional practice. This study examined the linkages between FGM and multiple sexual partnership in Mali and Sierra Leone - two African countries with a high prevalence of FGM. Data were from the 2018 Mali and 2013 Sierra Leone Demographic and Health Surveys, and the study sample comprised 4750 women from Mali and 16,614 from Sierra Leone. Multilevel logistic regression was used for the data analysis, with reported adjusted odds ratios (aOR) and associated 95% confidence intervals. In Mali, women who had not undergone FGM were less likely to have multiple sexual partners (aOR=0.60, CI=0.38-0.96) compared with those who had undergone FGM. In Sierra Leone, women who had undergone FGM (aOR=1.15, CI=1.02-1.30) were more likely to have multiple sexual partners compared with those who had not undergone FGM. Age, level of education, wealth quintile, sex of household head, community socioeconomic status, mass media exposure, and community literacy level were found to be associated with the likelihood of multiple sexual partnership among women in Mali and Sierra Leone. Comprehensive, age-group-based risk-reduction strategies, such as abstinence education and decision-making skills (assertiveness) training, are needed to reduce girls' and young women's engagement in multiple sexual partnerships. Policy interventions, such as anti-FGM legislation and initiatives like the 'Schooling for the Female Child' initiative aimed at reducing social inequality among girls and women, might help decrease FGM and the likelihood of health-compromising behaviours like multiple sexual partnership.

Female Genital Mutilation in Sudan: is a new era starting?

The World Health Organisation (WHO) defines female genital mutilation or cutting (FGM/C) as a violation of human rights and includes all procedures that involve partial or total removal of the external female genitalia, or other injury to the female genital organs for non-medical reasons. Sudan has one of the highest rates of FGM/C in the world with 86.6% girls and women aged between 15-49 years affected. Although FGM/C is still widely practiced across all of Sudan, social attitudes and norms towards the practice are changing, especially in urban areas. On 22 April 2020, the transitional Sudanese government criminalised FGM/C in Sudan when the Sovereign and Ministerial Councils endorsed the amendment to Criminal Law Article 141. Sudan is beginning a new era in terms of FGM/C. In order to achieve effective and long-lasting effects, efficient mechanisms, specifically allocated financial resources, and broader partnerships that include governmental bodies, civil society, community-based organisations, and international actors, must be put in place.

Hotspots of female genital mutilation/cutting and associated factors among girls in Ethiopia: a spatial and multilevel analysis

Background

Female genital mutilation/cutting (FGM/C) is a harmful traditional practice that violates the human rights of girls and women. It is widely practiced mainly in Africa including Ethiopia. There are a number of studies on the prevalence of FGM/C in Ethiopia. However, little has been devoted to its spatial epidemiology and associated factors. Hence, this study aimed to explore the spatial pattern and factors affecting FGM/C among girls in Ethiopia.

Methods

A further analysis of the 2016 Ethiopia Demographic and Health Survey data was conducted, and a total of 6985 girls nested in 603 enumeration areas were included in this analysis. Global Moran’s I statistic was employed to test the spatial autocorrelation, and Getis-Ord Gi* as well as Kulldorff’s spatial scan statistics were used to detect spatial clusters of FGM/C. Multilevel logistic regression models were fitted to identify individual and community level factors affecting FGM/C.

Results

Spatial clustering of FGM/C was observed (Moran’s I = 0.31, p-value < 0.01), and eight significant clusters of FGM/C (hotspots) were detected. The most likely primary SaTScan cluster was detected in the neighborhood areas of Amhara, Afar, Tigray and Oromia regions (LLR = 279.0, p < 0.01), the secondary cluster in Tigray region (LLR = 67.3, p < 0.01), and the third cluster in Somali region (LLR = 55.5, P < 0.01). In the final best fit model, about 83% variation in the odds of FGM/C was attributed to both individual and community level factors. At individual level, older maternal age, higher number of living children, maternal circumcision, perceived beliefs as FGM/C are required by religion, and supporting the continuation of FGM/C practice were factors to increase the odds of FGM/C, whereas, secondary or higher maternal education, better household wealth, and regular media exposure were factors decreasing the odds of FGM/C. Place of residency, Region and Ethnicity were also among the community level factors associated with FGM/C.

Conclusions

In this study, spatial clustering of FGM/C among girls was observed in Ethiopia, and FGM/C hotspots were detected in Afar, Amhara, Tigray, Benishangul Gumuz, Oromia, SNNPR and Somali regions including Dire Dawa Town. Both individual and community level factors play a significant role in the practice of FGM/C. Hence, FGM/C hotspots require priority interventions, and it is also better if the targeted interventions consider both individual and community level factors.

Trends and Determinants of Female Genital Mutilation in Ethiopia: Multilevel Analysis of 2000, 2005 and 2016 Ethiopian Demographic and Health Surveys

Background

Female genital mutilation (FGM) is a harmful practice that causes health-related problems in the life of the affected women and girls. Though FGM is declared as a human right violation, studies revealed it is being practiced throughout Ethiopia. Therefore, this study was conducted to assess the prevalence, trends, and predictors of FGM among reproductive-aged (1549 years) women in Ethiopia.

Methods

Trends of FGM among reproductive-age women were estimated using the three Ethiopian Demographic and Health Survey (EDHS): 2000 (n=15,367), 2005 (n=14,070) and 2016 (n=7248) data. Multilevel logistic regression analysis was conducted to identify both individual- and community-level factors of FGM using the latest (2016) EDHS. To adjust potential confounders, the analysis was conducted considering sample weighting, clustering, and stratifications using STATA-14 software.

Results

The prevalence of FGM among women of reproductive age in Ethiopia decreased from 79.91% in 2000 to 70.37% in 2016. Similarly, FGM among daughters of circumcised mothers decreased from 56.16% in 2000 to 16.76% in 2016. Being Muslim (adjusted odds ratio [AOR] 5.48; 95% confidence interval [CI]: 4.23, 7.09), attending higher education (AOR 0.40; 95% CI: 0.29, 0.54), 45–49 years old (AOR 5.06; 95% CI: 3.38, 7.57), marriage at ≥ 18 years (AOR 0.80; 95% CI: 0.66, 0.96), not working (AOR 1.20; 95% CI: 1.02, 1.41), married (AOR 1.41; 95% CI: 1.12, 1.77) and residing in peripheral region (AOR 3.0.4; 95% CI: 1.96, 4.70) were determinants of FGM.

Conclusion

Though the reduction of FGM among women of reproductive age in Ethiopia was minimal, it was encouraging among daughters of circumcised women over the last 16 years. Education, religion, age, age at marriage, occupation, marital status, and geographical regions were determinants of FGM. Combined and integrated interventions based on the identified factors are recommended to abandon FGM in Ethiopia.

Do educated women in Sierra Leone support discontinuation of female genital mutilation/cutting? Evidence from the 2013 Demographic and Health Survey

INTRODUCTION

Female genital mutilation/cutting (FGM/C) comprises all procedures that involve the total or partial elimination of the external genitalia or any injury to the female genital organ for non-medical purposes. More than 200 million females have undergone the procedure globally, with a prevalence of 89.6% in Sierra Leone. Education is acknowledged as a fundamental strategy to end FGM/C. This study aims to assess women's educational attainment and how this impacts their views on whether FGM/C should be discontinued in Sierra Leone.

METHODS

We used data from the 2013 Sierra Leone Demographic and Health Survey. A total of 15,228 women were included in the study. We carried out a descriptive analysis, followed by Binary Logistic Regression analyses. We presented the results of the Binary Logistic Regression as Crude Odds Ratios (COR) and Adjusted Odds Ratios (AOR) with 95% confidence intervals (CIs).

RESULTS

Most of the women with formal education (65.5%) and 15.6% of those without formal education indicated that FGM/C should be discontinued. Similarly, 35% of those aged 15-19 indicated that FGM/C should be discontinued. Women with a higher education level had a higher likelihood of reporting that FGM/C should be discontinued [AOR 4.02; CI 3.00-5.41]. Christian women [AOR 1.72; CI 1.44-2.04], those who reported that FGM/C is not required by religion [AOR 8.68; CI 7.29-10.34], wealthier women [AOR 1.37; CI 1.03-1.83] and those residing in the western part of Sierra Leone [AOR 1.61; CI 1.16-2.23] were more likely to state that FGM/C should be discontinued. In contrast, women in union [AOR 0.75; CI 0.62-0.91], circumcised women [AOR 0.41; CI 0.33-0.52], residents of the northern region [AOR 0.63; CI 0.46-0.85] and women aged 45-49 [AOR 0.66; CI 0.48-0.89] were less likely to report that FGM/C should be discontinued in Sierra Leone.

CONCLUSION

This study supports the argument that education is crucial to end FGM/C. Age, religion and religious support for FGM/C, marital status, wealth status, region, place of residence, mothers' experience of FGM/C and having a daughter at home are key influences on the discontinuation of FGM/C in Sierra Leone. The study demonstrates the need to pay critical attention to uneducated women, older women and women who have been circumcised to help Sierra Leone end FGM/C and increase its prospects of achieving Sustainable Development Goals (SDG) three and five.

Socio-economic and demographic determinants of female genital mutilation in sub-Saharan Africa: analysis of data from demographic and health surveys

Background

Owing to the severe repercussions associated with female genital mutilation (FGM) and its illicit status in many countries, the WHO, human rights organisations and governments of most sub-Saharan African countries have garnered concerted efforts to end the practice. This study examined the socioeconomic and demographic factors associated with FGM among women and their daughters in sub-Saharan Africa (SSA).

Methods

We used pooled data from current Demographic and Health Surveys (DHS) conducted between January 1, 2010 and December 31, 2018 in 12 countries in SSA. In this study, two different samples were considered. The first sample was made up of women aged 15–49 who responded to questions on whether they had undergone FGM. The second sample was made up of women aged 15–49 who had at least one daughter and responded to questions on whether their daughter(s) had undergone FGM. Both bivariate and multivariable analyses were performed using STATA version 13.0.

Results

The results showed that FGM among women and their daughters are significantly associated with household wealth index, with women in the richest wealth quintile (AOR, 0.51 CI 0.48–0.55) and their daughters (AOR, 0.64 CI 0.59–0.70) less likely to undergo FGM compared to those in the poorest wealth quintile. Across education, the odds of women and their daughters undergoing FGM decreased with increasing level of education as women with higher level of education had the lowest propensity of undergoing FGM (AOR, 0.62 CI 0.57–0.68) as well as their daughters (AOR, 0.32 CI 0.24–0.38). FGM among women and their daughters increased with age, with women aged 45–49 (AOR = 1.85, CI 1.73–1.99) and their daughters (AOR = 12.61, CI 10.86–14.64) more likely to undergo FGM. Whiles women in rural areas were less likely to undergo FGM (AOR = 0.81, CI 0.78–0.84), their daughters were more likely to undergo FGM (AOR = 1.09, CI 1.03–1.15). Married women (AOR = 1.67, CI 1.59–1.75) and their daughters (AOR = 8.24, CI 6.88–9.87) had the highest odds of undergoing FGM.

Conclusion

Based on the findings, there is the need to implement multifaceted interventions such as advocacy and educational strategies like focus group discussions, peer teaching, mentor–mentee programmes at both national and community levels in countries in SSA where FGM is practiced. Other legislative instruments, women capacity-building (e.g., entrepreneurial training), media advocacy and community dialogue could help address the challenges associated with FGM. Future studies could consider the determinants of intention to discontinue or continue the practice using more accurate measures in countries identified with low to high FGM prevalence.

Towards the elimination of FGM by 2030: A statistical assessment

In 2015, UN member states committed to eliminate female genital mutilation (FGM) by 2030 as part of the Sustainable Development Agenda. To reach this goal, interventions need to be targeted and guided by the best available evidence. To date, however, estimates of the number of girls and women affected by FGM and their trends over time and geographic space have been limited by the availability, specificity and quality of population-level data. We present new estimates based on all publicly available nationally representative surveys collected since the 1990s that contain both information on FGM status and on the age at which FGM occurred. Using survival analysis, we generate estimates of FGM risk by single year of age for all countries with available data, and for rural and urban areas separately. The likelihood of experiencing FGM has decreased at the global level, but progress has been starkly uneven between countries. The available data indicate no progress in reducing FGM risk in Gambia, Guinea-Bissau, Mali and Guinea. In addition, rural and urban areas have diverged over the last two decades, with FGM declining more rapidly in urban areas. We describe limitations in the availability and quality of data on FGM occurrence and age-at-FGM. Based on current trends, the SDG goal of eliminating FGM by 2030 is out of reach, and the pace at which the practice is being abandoned would need to accelerate to eliminate FGM by 2030. The heterogeneity in trends between countries and rural vs urban areas offers an opportunity to contrast countries where FGM is in rapid decline and explore potential policy lessons and programmatic implications for countries where the practice of FGM appears to remain entrenched.

Changing prevalence and factors associated with female genital mutilation in Ethiopia: Data from the 2000, 2005 and 2016 national demographic health surveys

Setting

Female genital mutilation (FGM) is a traditional surgical modification of the female genitalia comprising all procedures involving partial or total removal of the external female genitalia or other injury to the female genital organs for cultural or nontherapeutic reasons. It can be harmful and violates girls’ and women’s human rights. FGM is a worldwide problem but mainly practiced in Africa. FGM is still widely practiced in Ethiopia despite being made a criminal offence in 2004.

Objective

Using data from three Ethiopian Demographic Health Surveys (EDHS) conducted in 2000, 2005 and 2016 the objective was to assess changes in prevalence of FGM and associated factors among women of reproductive age and their daughters.

Methods

EDHS datasets for the three surveys included data on FGM prevalence and socio-demographic factors. After weighting, the data were analysed using frequencies, proportions and the chi square test for trend. Categorical variables associated with FGM in 2016 were compared using OpenEpi and presented as prevalence ratios (Pr) with 95% Confidence Intervals (CI). Levels of significance were set at 5% (P<0.05).

Results

There was overall decline in FGM prevalence (from 79.9% to 74.3% to 65.2%, P<0.001), especially in younger women aged 15-19 years, and in the proportion of women who believed that the practice should continue (from 59.7% to 28.3% to 17.5%, P<0.001). There was also a decreasing trend of FGM in the daughters of the mothers who were interviewed, with prevalence significantly lower in mothers who had not themselves undergone FGM. Most (88.3%) women with FGM had the surgery as a child with the procedure mainly performed by a traditional circumciser (87.3%). Factors associated with higher FGM prevalence and lack of progress over the sixteen years included living in certain regions, especially Somali where FGM prevalence remained consistently >95%, lack of school education, coming from rural areas and living in less wealthy households.

Conclusion

Although progress has been slow, the prevalence of FGM in Ethiopia has declined over time. Recommendations to quicken the trajectory of decline targeting integrated interventions to high prevalence areas focusing on mothers, fathers, youngsters, religious leaders and schools and ensuring that all girls receive some form of education.

Experiences of young women who underwent female genital mutilation/cutting

AIM AND OBJECTIVES

To describe the FGM/C experiences of young women living in Nigeria.

BACKGROUND

Globally, several activities have been targeted at ending female genital mutilation/cutting (FGM/C). However, the practice is ongoing, especially in countries such as Nigeria, which is reported to be having a population boom. Therefore, there is a need to investigate the FGM/C experiences of young women in such countries so that efforts towards ending it can be accelerated using evidence-based, community-led interventions.

DESIGN

A qualitative descriptive design.

METHODS

The study took place in two states of south-eastern Nigeria with a high prevalence of FGM/C. The snowball sampling method was used to recruit 22 women, aged 20-40, who had undergone FGM/C. Participant's experiences were explored through semi-structured interviews, and the qualitative content analysis was used for data analysis. The consolidated checklist for reporting of qualitative studies guided the reporting of this study.

FINDINGS

Three themes and seven subthemes emerged from the data. The themes were as follows: cultural issues, life as a circumcised woman and the future with FGM/C. Half of the participants could not recall their experiences on the day of their circumcision, as they were circumcised at infancy. However, those who were older when circumcised experienced it as a painful, traumatic experience forced upon them. Some of the participants experienced sexual and childbirth problems due to this procedure, and this was of great concern to them.

CONCLUSION

Female genital mutilation/cutting was a traumatic experience forced on the participants. They felt helpless as they could not choose and had to do the "right thing." Despite the trauma and complications caused by the cutting, some still supported the continuation of the practice.

RELEVANCE TO CLINICAL PRACTICE

Understanding the experiences of genitally mutilated women could assist healthcare practitioners in rendering quality, and contextualised services to these women.

Prevalence of female genital mutilation among women in Ethiopia: A systematic review and meta-analysis

Background

Female genital mutilation affects the social, psychological, spiritual and physical well-being of women. In Ethiopia, studies regarding the female genital mutilation were conducted in various settings and years.

Objective

This systematic review and meta-analysis was aimed to summarize the prevalence of female Genital Mutilation in Ethiopia.

Methods

A systematic search of articles was conducted in PubMed, African Journals Online (AJOL), Excerpta Medica database (EMBASE), SCOPUS, Web of Science, and JSTOR. Data were extracted using a standardized data extraction format prepared in Microsoft Excel. The data were analyzed using STATA version 11 software. Cochrane Q statistic was used to assess the presence of significant between-study heterogeneity. I² was used to quantify between-study heterogeneity. A leave-one-out sensitivity analysis and subgroup analysis based on a study period and setting were done. The funnel plot and Egger's regression tests were used to measure the presence of substantial publication bias. The pooled estimated prevalence of female genital mutilation was conducted using a DerSimonian and Laird random effects model.

Results

The pooled prevalence estimate of FGM was 77.28% (95% CI: 55.81, 98.76). The pooled prevalence was higher in studies conducted from 2013-2017 (78.39%, 95%CI: 48.24, 108.54) and studies conducted in Hospital (92.02: 95%CI: 55.81, 98.76).

Conclusion

The prevalence of Female Genital Mutilation is high. Therefore, interventions that are focused on health education, social support and advocacy are recommended.

Female genital mutilation/cutting in Sierra Leone: are educated women intending to circumcise their daughters?

Background

Female genital mutilation/cutting (FGM/C) has been recognized as a gross violation of human rights of girls and women. This is well established in numerous international legal instruments. It forms part of the initiation ceremony that confers womanhood in Sierra Leone. Girls and women who are subjected to this practice are considered to be ready for marriage by their parents and communities and are rewarded with celebrations, gifts, and public recognition. Following this, we examined the relationship between education and women’s FGM/C intention for their daughters in Sierra Leone.

Methods

We used cross-sectional data from the women’s file of the 2013 Sierra Leone Demographic and Health Survey (SLDHS) to explore the influence of education on FGM/C intention among women in the reproductive age (15–49). A sample of 6543 women were included in the study. Our analysis involved descriptive computation of education and FGM/C intention. This was followed by a two-level multilevel analysis. Fixed effect results were reported as Odds Ratios and Adjusted Odds Ratios with their respective credible intervals (CrIs) whilst results of the random effects were presented as variance partition coefficients and median odds ratios.

Results

Our findings showed that women who had no formal education were more likely to intend to circumcise their daughters [aOR = 4.3, CrI = 2.4–8.0]. Among the covariates, women aged 20–24 [aOR = 2.3, CrI = 1.5–3.4] were more likely to intend to circumcise their daughters compared to women between 45 and 49 years old. Poorest women were more likely to report intention of circumcising their daughters in the future compared with the richest [aOR = 2.1, CrI = 1.3–3.2]. We noted that, 63.3% of FGM/C intention in Sierra Leone is attributable to contextual factors.

Conclusion

FGM/C intention is more common among women with no education, younger women as well as women in the lowest wealth category. We recommend segmented female-child educational and pro-poor policies that target uneducated women in Sierra Leone. The study further suggests that interventions to end FGM/C need to focus on broader contextual and social norms in Sierra Leone.

Trends and Spatio-temporal variation of female genital mutilation among reproductive-age women in Ethiopia: a Spatio-temporal and multivariate decomposition analysis of Ethiopian demographic and health surveys

BACKGROUND

Female genital mutilation (FGM) is a serious health problem globally with various health, social and psychological consequences for women. In Ethiopia, the prevalence of female genital mutilation varied across different regions of the country. Therefore, this study aimed to investigate the trend and determinants of female genital mutilation among reproductive-age women over time.

METHODS

A secondary data analysis was done using 2000, 2005, and 2016 Demographic Health Surveys (DHSs) of Ethiopia. A total weighted sample of 36,685 reproductive-age women was included for analysis from these three EDHS Surveys. Logit based multivariate decomposition analysis was employed for identifying factors contributing to the decrease in FGM over time. The Bernoulli model was fitted using spatial scan statistics version 9.6 to identify hotspot areas of FGM, and ArcGIS version 10.6 was applied to explore the spatial distribution FGM across the country.

RESULTS

The trends of FGM practice has been decreased from 79.9% in 2000 to 70.4% in 2016 with an annual reduction rate of 0.8%. The multivariate decomposition analysis revealed that about 95% of the overall decrease in FGM practice from 2000 to 2016 was due to the difference in the effects of women's characteristics between the surveys. The difference in the effects of residence, religion, occupation, education, and media exposure were significant predictors that contributed to the decrease in FGM over time. The spatial distribution of FGM showed variation across the country. The SaTScan analysis identified significant hotspot areas of FGM in Somali, Harari, and Afar regions consistently over the three surveys.

CONCLUSION

Female genital mutilation practice has shown a remarkable decrease over time in Ethiopia. Public health programs targeting rural, non-educated, unemployed, and those women with no access to media would be helpful to maintain the decreasing trend of FGM practice. The significant Spatio-temporal clustering of FGM was observed across regions in Ethiopia. Public health interventions must target the identified clusters as well.

Decision-making in the practice of female genital mutilation or cutting in Sudan: a cross-sectional study

Background

Female genital mutilation or cutting (FGM/C) is a form of violence against women and girls that is widely performed in about 30 countries in Africa, Middle East and Asia. In Sudan, the prevalence of FGM/C among women aged 15-49 years was 87% in 2014. Little is known about household decision-making as it relates to FGM/C. This study aimed to understand the key people involved in FGM/C-related decisions, and to assess predictors of households' decision to cut or not cut the youngest daughter and the reasons for these decisions.

Methods

We drew on household survey data collected as part of a larger cross-sectional, mixed methods study in Sudan. The analytical sample comprised of data from 403 households that both reported that they had discussion around whether to cut the youngest daughter aged 19 years or younger and arrived at a decision to either cut or leave her uncut. Descriptive statistics summarizing the people involved in FGM/C-related decisions and the reasons for decisions are presented. We also present logistic regression analyses results summarizing predictors of households' decision to leave the youngest daughter uncut.

Results

Household decision-making on FGM/C involved discussions among the nuclear and extended family, and non-family members. Mothers and fathers were found to be the key decision makers. A greater proportion of fathers were involved in instances where the final decision was to leave the daughter uncut. Thirty-six percent of households decided to leave the youngest daughter uncut. State of residence, mothers' level of education and FGM/C status and exposure to FGM/C-related information or campaigns were associated with households' decision to leave the daughter uncut. Health concerns were the most commonly cited reason for deciding not to cut their daughters (57%), while custom or culture was the most commonly cited reason for households deciding to cut their daughter (52%).

Conclusion

FGM/C-related decisions result from deliberations that involve many people. Our findings underscore the important role that fathers play in decision-making and highlight the need to involve men in FGM/C programs. Findings also stress the need to understand and address the drivers of FGM/C.

Estimating geographic variations in the determinants of attitude towards the practice of female genital mutilation in Nigeria

Female genital mutilation (FGM) has persisted in Nigeria despite the very harmful effects on its victims. Massive inequality in the demographic and socioeconomic status of the Nigerian populace, coupled with marked differences in cultural values, have led to lopsided patterns of most health indicators based on the geographical location. The risk factors of health indicators are equally expected to vary according to location. This study aimed to explain the spatial variations in the risk factors for female cutting in Nigeria. Data were from the geo-referenced 2013 Nigeria Demographic and Health Survey. The objective was to estimate the spatially varying relationships of the factors influencing women's attitude towards female cutting in Nigeria and to identify how the variables exact influence across the states using geographically weighted logistic regression analysis - a technique that allows for spatially varying relationships among variables to be established. The results showed that women's higher educational level and higher household wealth lowered the desire for continuation of FGM everywhere in the country, but the effects of most other variables varied in direction, strength and magnitude. The findings suggest the use of local approaches to address the factors that encourage the continuation of female cutting in Nigeria.

Prevalence and factors associated with female genital mutilation among women of reproductive age in the Bawku municipality and Pusiga District of northern Ghana

BACKGROUND

Globally, three million girls are at risk of female genital mutilation (FGM) and an estimated 200 million girls and women in the world have undergone FGM. While the overall prevalence of FGM in Ghana is 4%, studies have shown that the overall prevalence in the Upper East Region is 38%, with Bawku municipality recording the highest at 82%.

METHODS

This study used a cross-sectional design with a quantitative approach: a survey with women of reproductive age (15-49).

RESULTS

Among all respondents, 830 women who participated in the study, 61% reported having undergone FGM. Of those circumcised, 66% indicated their mothers influenced it. Three quarters of the women think FGM could be stopped through health education. Women who live in the Pusiga district (AOR: 1.66; 95% CI: 1.16-2.38), are aged 35-49 (AOR: 4.24; 95% CI: 2.62-6.85), and have no formal education (AOR: 2.78; 95% CI: 1.43-5.43) or primary education (AOR: 2.10; 95% CI: 1.03-4.31) were more likely to be circumcised relative to those who reside in Bawku Municipal, are aged 15-24, and had tertiary education. Likewise, married women (AOR: 3.82; 95% CI: 2.53-5.76) were more likely to have been circumcised compared with unmarried women. At a site-specific level, factors associated with FGM included age and marital status in Bawku, and age, marital status, and women's education in Pusiga.

CONCLUSION

Female Genital Mutilation is still being practiced in the Bawku Municipality and the Pusiga District of northern Ghana, particularly among women with low socio-economic status. Implementing interventions that would provide health education to communities and promote girl-child education beyond the primary level could help end the practice.

Female Genital Mutilation in Sudan

BACKGROUND:

Female genital mutilation or female circumcision (FGM) is a serious health problem in Sudan. This procedure is harmful to women and causes many complications during pregnancy and childbirth.

OBJECTIVE:

This study aims to determine the female genital mutilation (FGM) and its associated factors in Sudan.

SUBJECTS AND METHODS:

Data from Sudan Multiple Indicator Cluster Survey (MICS - UNICEF) was used in this research. The survey was carried out in 2014 and included women aged between 14 – 49 years. A logistic regression model was used to find an association between dependent and independent variables.

RESULT:

Total numbers of 21947 women were included in the survey and out of the 6249 (28.5 %) from urban and 15698 (71.5%) from rural areas. The prevalence of female circumcision was 89%. Women who had circumcised daughters were 32.1 %. The highest prevalence of FGM was reported from South Kordofan state with 7.8%, and lowest was in Red Sea state (7.6%). A significant association was observed between circumcised women and their marital status, daughter circumcision, and the level of education.

CONCLUSION:

The practice of female genital mutilation is spread all over the country. Poor women with low level of education are at high risk for this phenomenon. More efforts have to be provided to end this dangerous practice.

Attitude toward female genital mutilation among Somali and Harari people, Eastern Ethiopia

Background

Female genital mutilation (FGM) is a worldwide problem, and it is practiced by many communities in Africa and Asia as well as immigrants from those areas. This practice results in short- and long-term health consequences on women’s health. Like many other developing countries, FGM is widely practiced in Ethiopia, especially among Somali and Harari ethnic groups. Despite intensive campaigns against FGM in Ethiopia, since 2011, it has been practiced in the aforementioned communities. There is no recent information as to whether these campaigns have an impact on the attitude and practice of the community regarding FGM. This qualitative research was aimed at exploring the attitudes of Somali and Harari people between 18 and 65 years toward FGM.

Methods

A purposive sampling technique was used to recruit 64 (32 in each region) participants. Data were collected from October to December 2015 in Somali and Harari Regions.

Results

The findings showed that there was a strong support for the continuation of the practice among female discussants in Somali region, whereas male discussants from the same region and the majority of the participants from Harari region had a positive attitude toward the discontinuation of the practice. Marriageability was the major reason for practicing FGM in Somali region, whereas making girls calm, sexually inactive, and faithful for their husbands were mentioned in Harari region. Although young men in both the regions prefer to marry uncircumcised girls, the study showed that there are some differences in the attitude toward the FGM practice between the people in the two regions.

Conclusion

The findings show that there is an attitudinal difference between the people in the two regions, which calls for behavioral change communication using women-centered approach and culturally appropriate strategies. As young people in both the regions had the intention to marry uncircumcised girls, there has to be a strong advocacy and multisectoral collaboration to stop FGM in both the regions.